Twists & Turns VBS Registration Form 2023

Child 1 Full Name

Child's Birthdate (Month/Date/Year)

Level child will have completed as of June 20, 2023

Preschool or PreK Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade

T-shirt Size

Youth XS Youth S Youth M Youth L Youth XL Other (please specifiy in notes to Director below)

Child 2 Full Name

Child's Birthdate (Month/Date/Year)

Level child will have completed as of June 20, 2023 Preschool or PreK Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade

T-shirt Size Youth XS Youth S Youth M Youth L Youth XL Other (please specifiy in notes to Director below)

Child 3 Full Name

Child's Birthdate (Month/Date/Year)

Level child will have completed as of June 20, 2023 Preschool or PreK Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade

T-Shirt Size Youth XS Youth S Youth M Youth L Youth XL Other (please specifiy in notes to Director below)

Please list any allergies, medical conditions, or special needs that would help us to best care for your child(ren)

Is there anything else you would like the Director to know?

Address

Parent/Guardian 1 Name

Parent/Guardian 1 Email

This address will receive a confirmation email

Parent/Guardian 1 Phone

Parent/Guardian 2 Name

Parent/Guardian 2 Email

Parent/Guardian 2 Phone

Emergency Contact: Please list first name, last name, and phone number for someone besides the listed parents or guardians.

Please list anyone besides parents/guardians who has permission to pick up your child.

Do you give permission to Neelsville Church to use photos of your child for website, social media, or other promotional use? Please note that we will never post children's names to respect privacy.

Yes No

What church do you attend? If you don't attend church, please write "none."

Would you like to receive our weekly e-newsletter with updates on Neelsville Presbyterian Church and its Children's Ministry?

Yes, please. No, thank you. I'm already receiving these updates.

By typing my first and last name and today's date, I hereby release Neelsville Church from liability and hold the church and its representatives harmless for the duration of The Twists & Turns VBS Program.

Twists & Turns VBS runs from 5:30-8:00 pm. Please indicate which dates you expect to be in attendance. Wednesday July 12, July 19, July 26, and August 2. Thank you!

Payment

If you'd like to help with supplies for VBS, you can purchase items through our Amazon wish list and ship them directly to our staff. Your donation is greatly appreciated!

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Twists & Turns VBS Registration Form 2023

Description

Please Fix the Following